Spinal Cord Stimulation for Functional Restoration in Spinal Cord Injury: A Narrative Review

Spinal cord injury (SCI) leads to loss of motor, sensory, and autonomic functions, posing challenges for individuals and healthcare systems. Traditional rehabilitation has limitations in restoring lost functions. Spinal cord stimulation (SCS) is emerging as a therapeutic approach for neurological recovery. It promotes neuroplasticity and activates residual neural pathways, potentially enabling functional improvements. This review explores SCS for neurological recovery in SCI, focusing on its mechanisms, clinical evidence, and future directions. Both invasive (epidural) and noninvasive (transcutaneous) techniques are discussed.

• 1
  SCS activates large-to-medium afferent fibers, enhancing the interneural connections between sensory afferents and motoneurons. This strengthens monosynaptic reflex activation onto motoneurons that control agonist muscles.
• 2
  Spinal cord circuits can independently process somatosensory information and adapt motor outputs, even when disconnected from the brain. SCS reorganizes propriospinal circuitry and engages central pattern generators (CPGs) for rhythmic outputs.
• 3
  SCS enhances motoneuron excitability to descending supraspinal inputs, including corticospinal, reticulospinal, and rubrospinal tracts. This contributes to sensory prediction, real-time adjustments, and motor memory.